Cervical Cancer Elimination in Scotland Expert Group Final Report

3. Executive Summary

This report sets out, for the Minister for Public Health and Women’s Health, the work needed to eliminate cervical cancer in Scotland as a public health problem. While it highlights that Scotland is making considerable progress towards the elimination of cervical cancer, improvement is required to ensure that elimination is achieved.

While the World Health Organisation has established specific targets, the Expert Group and the three subgroups (covering vaccination, screening and treatment) have made specific recommendations to ensure that efforts in Scotland are equitable and inclusive for all.

HPV Vaccination

The Public Health Scotland (PHS) study^[4] – which indicates that, to date, no cases of cervical cancer caused by HPV types targeted by the vaccine have been detected among fully vaccinated girls who received their first HPV vaccine dose between the ages of 12 and 13 – underscores the importance of vaccination as a crucial measure in preventing cervical cancer. In addition, a recent study^[5] using population health data, shows that the vaccine continues to be effective more than 12 years after it was given, in women who came forward for cervical screening. Addressing disparities in HPV vaccination rates and maximising opportunities for young individuals to receive the vaccine has been, and must continue to be, a central focus. Engaging with key stakeholders, including the workforce involved in vaccinations – to share best practice – and meeting with young individuals to gather their valuable insights, will be a primary focus of this work. Furthermore, continuous support from other agencies and educational bodies, which are instrumental in facilitating the vaccination process, will also be essential. Individual schools need to be fully supportive of the process if the highest uptake is to be achieved.

Screening

While universal coverage of HPV vaccination will move us closer to cervical cancer elimination, increasing the uptake of screening is also essential. Women who finished secondary school before 2008 were not eligible for vaccination; most of them will have been exposed to HPV and some of them will already have pre-malignant disease. Only screening and early treatment can eliminate cervical cancer in these women. The strategic promotion of cervical screening, including self-sampling options, for both women who are unvaccinated and those in under-screened communities will significantly enhance our ability to reach individuals who may not otherwise participate in screening. Substantial optimisation work is already underway in the Cervical Screening Programme; the Scottish Equity in Screening Strategy; and the Scottish Vaccination and Immunisation Programmes.

Treatment

Early detection and treatment of cervical cancer remain a national priority, within the Scottish Government and across NHS Scotland. Our strategic aim is to improve cancer survival and provide excellent, equitably accessible care. The strategy and plan have a focus on reducing inequities in access to cancer care and cancer outcomes.

The cancer quality performance indicators (QPI) programme is a vital part of ensuring people have access to safe, effective and person-centred care. Four of the five cervical cancer QPIs relate to treatment (the fifth to diagnosis). The latest cervical cancer QPI report in September 2024 shows that the target was met for four of the five indicators. The results show excellent performance with only QPI 5 Surgical Margins narrowly missing the target, by just one case.

To ensure cancer quality performance indicators remain relevant to clinical practice as it continues to evolve these indicators have recently been updated in April 2025 and will be monitored going forward, thus assuring the continued high-quality care of care delivered.

Conclusion

The Scottish Government aims to eliminate cervical cancer as soon as possible. Modelling using Scottish data, including cancer incidence, HPV vaccination rates, vaccine effectiveness estimates, and cervical screening coverage suggests that, with current levels Scotland could eliminate cervical cancer as a public health problem within the next 25 years (between 2046 and 2050). However, the projections indicate stark inequalities:

• women residing in the least deprived areas may meet this target as early as 2036-2040
• women residing in the most deprived areas, may never reach elimination without targeted interventions.

To achieve earlier elimination and reduce inequalities, higher HPV vaccine uptake and increased screening at all ages are needed, particularly in the most deprived groups. Taking by far the most optimistic scenario – achieving 90% vaccine uptake and screening coverage in the most deprived women and extending the age range for catch-up vaccination for women^[6] - overall elimination could be brought forward to 2036-2040 at a population level but would still take until 2045 in the most deprived parts of Scotland.

Achieving elimination by 2040 is an ambitious goal. Success will depend on strong commitment to implementing the recommendations in this report, securing the necessary resources, and working together with determination.